Peer-based Addiction Recovery Support - NAADAC

1 PPeeeerr--bbaasseedd AAddddiiccttiioonn RReeccoovveerryy SSuuppppoorrtt HHiissttoorryy,, TThheeoorryy,, PPrraaccttiiccee,, aanndd SScciieennttiiffiicc EEvvaalluuaattiioonn William L. White, MA Great Lakes Addiction Technology Transfer center Philadelphia Department of Behavioral Health and Mental Retardation Services i Dedication This monograph is dedicated to: Barbara Weiner and Rebecca Rowe of Hazelden Library, and to Stephanie Merkle and Christopher Roberts, research assistants at Chestnut Health Systems. This monograph was possible only through their tenacious efforts to procure hundreds of historical documents, scientific studies, trade journal articles, posted papers, conference presentations, and other unpublished manuscripts.

2 Barbara, Rebecca, Stephanie and Christopher, and their counterparts around the country receive far less acknowledgment for their contributions to the field than they deserve. Thomasina Borkman, for her pioneering work on experiential learning and Peer-based Recovery Support organizations. Those working on the front lines of Peer-based Addiction Recovery Support services. Thank you for opening your lives and your organizations to me. ii iiiTable of Contents Welcome from Lonnetta Albright and Michael Flaherty, PhD .. 1 Foreword by Arthur C. Evans, PhD and Beverly J. Haberle, MHS .. 3 Abstract .. 7 Introduction Summary of Key 9 The Recovery Management Monograph Series .. 9 Purpose of the Current 11 A Note on Language .. 12 A Caution to the 12 Acknowledgments.

3 13 Chapter One: Defining Peer-based Recovery Support Services Summary of Key 15 Defining peer Recovery 16 Distinguishing Professional and peer Support .. 19 Core Characteristics of P-BRSS 22 Varieties of peer Recovery Support 25 Core 27 Treatment Adjunct or Alternative .. 29 Chapter Two: The History of Peer-based Recovery Support Services Summary of Key 31 Solo Practitioners .. 34 peer Recovery Support and Religious/Cultural Revitalization Movements .. 35 Secular Recovery Mutual-aid Societies .. 36 Spiritual Recovery Mutual-aid societies .. 37 Religious Recovery Mutual-aid societies .. 37 Family-Focused Recovery Support Societies .. 38 Occupation- based Recovery Support Groups .. 38 Shared Characteristics of Recovery Support 38 Recovery Support for Special Populations.

4 39 Gender-specific mutual-aid 39 Age-specific Recovery Support .. 40 Recovery mutual aid and advocacy in communities of color .. 40 Recovery Support for and within the LGBT community .. 41 Recovery Support for people with co-occurring 41 Recovery Support for people embedded within the criminal justice 41 Recovery mutual aid in rural Geographical Accessibility of Recovery Mutual-aid Groups .. 42 Internet- based Recovery 47 Recovery Community Service Institutions and Organizations .. 47 Recovery Social Clubs .. 48 Recovery Advocacy Organizations .. 49 Recovering People Working in Non-professional Support Roles in .. 50 Addiction Treatment Recovering People Working in Professional Roles in Addiction Treatment.

5 53 Current Recovery Coaching Practices in the Public and Private Sectors .. 62 ivChapter Three: The Theoretical Foundations of Peer-based Recovery Support Summary of Key 67 Nothing about us without us .. 69 The Wounded Healer Tradition .. 71 The Power of Calling (Amends in Action) .. 73 Experiential 74 Chronic Illness and peer 78 Charisma and 80 Spirituality and Recovery .. 84 Storytelling and the Power of Mutual Identification .. 85 Stigma and The Dynamics of 88 Sharing Recovery Capital .. 92 The Helper Therapy Principle .. 93 Individual, Community, Culture .. 94 Cultures of Addiction and 96 Preventing Harm in the Name of Help .. 97 Stewardship of Community 99 The Threats of Anti-professionalism and Professionalism .. 100 Primacy of Personal Recovery and Importance of Self-Care.

6 103 Role of Risk in 105 The Value of P-BRSS .. 105 Criticism of P-BRSS .. 107 Testing the Theoretical Foundations of P-BRSS .. 109 Chapter Four: Scientific Evaluation of Peer-based Support : Studies of the Effects of Participation in Recovery Mutual-aid Societies Summary of Key Findings .. 113 Limited Scope of Research on Recovery Mutual-aid Societies .. 115 Role of Mutual Aid in Recovery Outcomes .. 117 Variability of Response .. 119 Effectiveness across Diverse Populations .. 120 125 The Question of Harm (Iatrogenesis).. 126 Potent Ingredients of Recovery Mutual Aid .. 128 Additive Effects of Professional Treatment and Mutual 130 Timing of 131 Linkage Procedures and Participation 132 Linking Adolescents to Recovery Support Groups.

7 133 Early Drop-out 134 Dose and Intensity of Participation Effects .. 136 Frequency of Participation .. 136 Duration of 137 Role of Internet- based Recovery 138 Relationship between Helping and Helper Recovery Outcomes .. 139 Studies of Family Support Groups .. 140 vChapter Five: Scientific Evaluation of Peer-based Services: Studies of the Effects of Participation in other Recovery Community Institutions Summary of Key Findings .. 145 Recovery Social Clubs .. 146 Recovery Community Centers .. 147 Recovery 149 Recovery Colonies .. 154 Recovery Schools .. 155 Peer-based Occupational Recovery Support ..158 Recovery Ministries/ Recovery Churches .. 160 Other Recovery Support 162 Chapter Six: Scientific Evaluation of Peer-based Services: Studies of Recovering People Working in Addiction Treatment Summary of Key Findings.

8 165 Science versus Stereotypes ..166 Recovery Representation in Addiction Treatment .. 167 The Role Transformation of Addiction Counselors in Recovery .. 171 Demographic Profile of Counselors in Recovery .. 174 Prior Treatment/ Recovery Experience of Counselors in Recovery .. 174 Pre-service Educational Functioning of Counselors in 175 Educational Levels of Recovering People Working as Addiction Counselors .. 175 Certification, Licensure, and Clinical Effectiveness ..176 Compensation of Recovering Counselors versus Counselors Without a .. 178 History of Addiction Personality Characteristics of Recovering Addiction Counselors .. 178 Beliefs and Attitudes of Recovering Addiction 179 Attitudes and Behaviors of Recovering Counselors Related to 184 based Practices Role Perceptions of Recovering Addiction Counselors.

9 186 Recovery Status and Client Perceptions of Credibility and 186 Counselor Recovery Status and Therapeutic Alliance .. 188 Counselor Recovery Status and Ethical 189 Counselor Recovery Status and Client Recovery Outcomes .. 191 Recovery Status and General Job Performance Factors .. 196 Vulnerability to Relapse among Counselors in Recovery .. 196 Influence of Recovery Status on Supervisory Relationships .. 197 Evaluation of Treatment Models Staffed by Recovering People .. 198 Evaluation of Recovery Volunteer Programs Linked to Addiction .. 202 Treatment or Medical Treatment Relevant Studies on Peer-based Services from Allied 204 Commentary on Lack of Distinctive 207 viChapter Seven: Recent Studies of Recovery Coaching and P-BRSS Summary of Key Findings.

10 209 The Recovery Community Services Program (RCSP) .. 209 The Access to Recovery (ATR) 211 Studies of Service Elements related to P-BRSS .. 213 Chapter Eight: A P-BRSS Research Agenda Summary of Key Findings .. 217 Toward a Recovery Research Agenda .. 217 Communities of Recovery as Ethno-cultural 218 Research on Recovery Mutual-aid 220 Participation in Other Recovery Community 221 Recovery Representation in Professional 221 Person-specific Factors Affecting Recovery 222 P-BRSS and Stages of Recovery ..223 P-BRSS Service 223 Service Ingredients and Recovery 224 Interaction Between P-BRSS and Professional Treatment .. 225 P-BRSS and Family/Community Recovery Outcomes .. 226 Organizational Contexts and P-BRSS 227 Concerns About P-BRSS.